Keeping Children Healthy During and After COVID-19 Pandemic: Meeting Youth Physical Activity Needs

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DeFina, Breanna L. Natale, Shelby E. Thiele, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-142643/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Mar, 2021 Read the published version in BMC Public Health → Version 1 posted 15 You are reading this latest preprint version Abstract Background: The purpose of this study was to: 1) examine the maintenance of Physical Education and physical activity during the distance learning time, 2) determine the resources educators are utilizing to deliver PE curricula, and 3) understand the challenges experienced by educators during distance learning. Methods: A survey was sent to a cohort of school-based fitness assessment software users. Respondents were largely school-based individuals including PE teachers (n= 1,789), school (n=62), and district administrators (n=64). nurses (n=3), and “other” (n =522). Results: Of 2,440 respondents, most were from a city or suburb (69.7%), elementary or middle school (72.3%), and had Title 1 status, an indicator of low socioeconomic status, (60.4%). Most campuses were closed during the COVID-19 pandemic (97.8%). Of the schools closed during the pandemic, only 2.8% had no prior PE requirements and that increased to 21% during the pandemic. In schools that remained open during the pandemic, 7.7% had no prior PE requirements and this increased to 60.5%. Importantly, 79% of respondents reported that students were either “significantly less” or “somewhat less” physically active during the closure. For closed schools, the most frequently cited challenges included “student access to online learning“, “teacher/student communication” and “teacher remote work arrangements”. For open schools, the most commonly reported challenges included “social distancing”, “access to gymnasium/equipment”, and “concern for personal health and wellbeing”. Conclusion: The COVID-19 pandemic has caused important reductions in PE requirements and time engaged in physical activity. Challenges experienced by teachers were identified for closed and open schools. Health Economics & Outcomes Research Health Policy physical education physical activity pandemic Figures Figure 1 Figure 2 Figure 3 Background In December 2019, a cluster of pneumonia like cases began to appear in China caused by a previously unknown virus, SARS-CoV-2 . The known cases of disease caused by this virus (COVID-19) grew at an exponential rate causing the World Health Organization (WHO) to declare COVID-19 a pandemic in March 2020. By early September, approximately 25.6 million confirmed cases were diagnosed worldwide with over 850,000 deaths across more than 200 countries (Organization, 2020b ). The pandemic nature of COVID-19 led to extraordinary societal measures aimed at containing the virus including closure of schools, social distancing, and sheltering in place at home across the United States (US) (Lewnard & Lo, 2020 ). The impact of prolonged school closures on students undergoing “distance learning” for a pandemic is unknown. During extended breaks from schools, such as summertime, there are significant challenges including “summer learning loss” which reflects not only stagnation of learned information but also regression. From an academic perspective, the loss is greater in spelling skills and math computation than reading (Stewart, Watson, & Campbell, 2018 ). These losses are more pronounced among children with low socioeconomic status, learning disabilities, and for whom English is a second language (National Academies of Sciences et al., 2019). In addition to academics, children’s health suffers during these breaks as body mass index (BMI) is known to increase during the summer as much as 5.2 percentile points in one study evaluating 3,588 ethnically diverse children (Moreno, Johnston, & Woehler, 2013 ). A smaller study evaluating the impact of break duration on weight showed that shorter breaks (3 and 7 weeks) mitigated increases in BMI versus 12-week breaks. Finally, children who participated in organized summer sports had significant improvement in their cardiovascular fitness compared to non-participants (Brusseau, Burns, Fu, & Weaver, 2019 ). The current norm of distance learning, born out of necessity for social distancing, will likely have parallel effects. Given the known, negative impact of extended school breaks on youth health, it is critical to understand how current remote schooling affects physical activity levels of children. Many schools and school districts are faced with the challenge of finding the best approaches to deliver distance education including Physical Education (PE). While basic subjects such as math, science and English adapt well to distance learning, less is known about PE. Additionally, social distancing and sheltering at home may decrease opportunities for physical activity. Experts continue to emphasize the importance of a physically active lifestyle for health and stress management, assuming appropriate precautions (Organization, 2020a). The purpose of the current study was to 1) examine the maintenance of PE and physical activity during the distance learning time, 2) determine the resources educators are utilizing to deliver PE curriculum, and 3) understand the challenges experienced by physical educators during distance learning. Methods The “Meeting Children’s Physical Activity Needs during the COVID-19 Pandemic” questionnaire was developed to focus on three domains: 1) descriptive characteristics (job title of survey respondent, school location, school/district type and classification, and Title 1 status), 2) access to PE and physical activity, and 3) challenges associated with delivering PE and physical activity during the pandemic. To address these aims, the authors developed a new questionnaire. In general, closed-ended response format was used to allow for efficient data aggregation and analysis. Further, emphasis was placed on limiting the number of questions for ease of administration while still capturing adequate information. The face validity was assessed by experts in the field. The questionnaire was then entered into Qualtrics XM® (SAP America Inc., Philadelphia, PA). Pretesting was accomplished by three experienced researchers with subject matter expertise. The target population was selected from individuals with available email addresses within a single fitness assessment software (FitnessGram®), a tool to collect school-based fitness assessment data on children grades 3 to 12. This tool is widely used in the US and allowed for a diverse sample of respondents in terms of socioeconomics, regions, and states. Each survey participant answered a maximum of 15 questions based on their institution’s educational environment. FitnessGram users consist predominantly of PE teachers and school/district administrators including current or previous participants in The Cooper Institute Youth Programs (NFL Play 60 FitnessGram Project and the Healthy Zone™ School Program). On April 23rd, 2020, the questionnaire was distributed to a convenience sample of 60,198 email contacts in the fitness assessment software contact database representing 29,786 active users and 30,412 prior users. Within the active contacts, 6,839 schools were represented. The prevalence of viable and current email addresses in this database is unknown, making a definitive response rate unclear. In order to enhance response, four reminder emails were sent at approximately two day intervals and a giftcard raffle incentive was offered to participants. The deadline for completing the survey was May 4th, 2020 at 11:59 PM. A one-week response time was chosen at the guidance of school administration and to ensure availability of results well before fall planning. Ultimately, 3,159 individuals responded to the survey. Of those, 594 individuals provided no answers and 125 provided partial demographic information, but answered no study-related questions. This resulted in a final analytic sample of 2,440. An introductory e-mail was sent to potential participants with study information, including the voluntary nature, and informed consent was implied when the respondent actively initiated the questionnaire. No identifying information was utilized in the study analysis. The research project and methodology were approved by The Cooper Institute Scientific and Institutional Review Boards. Responses were exported from the Qualtrics XM® online survey platform and analyzed in SAS/STAT®, version 9.4 (SAS Institute, Inc. Cary NC USA). Descriptive statistics on respondent locations, job titles and school classification and status were tabulated along with selected responses on PE requirements and delivery before and during the pandemic. Changes in hours of PE required before and during the pandemic were tested using rank-sum statistics. The trend in responses across a Likert scale of accumulated physical activity changes among respondents whose school was closed was based on a model of log-linear counts. We considered each respondent as an independent observation, taking the view that respondents answered according to their own experiences, not as agents of a particular school or district. Results Descriptive characteristics of respondents are presented in Table 1 . The majority of respondents were PE teachers (n = 1,789), followed by district (n = 64) and school (n = 62) administrators, and nurses (n = 3). An additional 522 survey respondents chose the “other” category, which consisted of classroom teachers, coaches, PE department chairs, athletic directors, and information technology personnel. The final sample of respondents had representation from each of the 50 US states, the District of Columbia and Puerto Rico. Additionally, 41 participants reported residing outside of the US. Overall, we saw little regional variation in the results. The greatest number of participants were from a city or suburb (69.7%), elementary or middle school (72.3%), and had Title 1 status, an indicator of low socioeconomic status, (60.4%). The vast majority of respondents reported their campus being closed during the COVID-19 pandemic (97.8%) with 97.4% of school closures occurring during the month of March 2020. Table 1 Descriptive characteristics of survey respondents. Characteristic N (%) Job Title (n) - Physical Education Teacher - District Administrator - School Administrator - Nurse - Other 2,440 1,789 (73.3) 64 (2.6) 62 (2.5) 3 (0.1) 522 (21.4) School/District Type - City - Suburb - Town - Rural - I don’t know 2,440 896 (36.7) 806 (33) 385 (15.8) 315 (12.9) 38 (1.6) School Classification - Elementary - Middle - High - Other 1,846 809 (43.8) 526 (28.5) 369 (20) 142 (7.7) Title 1 Status - Yes - No - I don’t know 1846 1114 (60.4) 614 (33.3) 118 (6.4) United States Regional Breakdown - Midwest - Northeast - South - West 2,424 603 (24.7) 242 (9.9) 1238 (50.7) 314 (12.9) Closed During the Pandemic - Yes - No 2432 2379 (97.8) 53 (2.2) Closure Month - Prior to March 2020 - March 2020 - April 2020 - May 2020 2340 15 (0.6) 2281 (97.4) 40 (1.7) 4 (0.2) Survey participants were asked if their school had access to distance learning prior to the COVID-19 pandemic. The largest percentage of respondents reported either “no access” (19.7%) or “I don’t know” (18.9%) to the availability of distance learning. For those schools with a distance learning infrastructure, math and science were most commonly available at 19.5% and 17.4%, respectively. Health and PE lagged behind with 12.3% and 12.1% identifying these subjects as part of distance learning prior to the COVID-19 pandemic. For those schools that closed their campuses, 86.1% were reportedly able to deliver PE remotely. The preferred methods of delivering such PE curricula were via distance learning (47.7%), at-home resources (26.6%), and parent collaboration (15.3%). Prior to the COVID-19 pandemic, only 2.8% and 7.7% of pandemic closed and open schools, respectively, had no PE requirements (Fig. 1 ). The most common mandatory PE time was 1–2 hours/week. During the pandemic, the percentage of schools with no PE requirement increased for both closed (21%) and open schools (60.5%). Furthermore, the total closed schools requiring at least 1 hour of PE/week increased and the percentage of 3 and ≥ 4 required hours/week decreased. Overall, the survey results show that mandatory PE was maintained in the closed schools to a larger degree than open schools. In addition to the PE related questions, we sought to determine the amount of physical activity and exercise obtained by students following the onset of the pandemic compared to the amount in a typical school day. Nearly 79% of survey respondents reported that students were accumulating either “significantly less” or “somewhat less” activity during the closure (Fig. 2). Respondents from Title 1 schools reported less physical activity for students during the shut-down than respondents from non-Title 1 schools or respondents unaware of their school’s Title 1 standing (p < 0.001). When able to deliver physical activity, the most commonly cited methods included at-home resources such as GoNoodle, OPEN, or YouTube (29%), e-learning platforms (27.9%), or virtual fitness/workouts by PE teachers (25.6%). Finally, the survey addressed the challenges experienced by teachers delivering PE in both closed (Fig. 3 , A.) and open (Fig. 3 , B.) schools. For schools closed during the pandemic, the three most frequently cited challenges included “student access to online learning” (23.3%), “teacher/student communication” (14.3%), and “teacher remote work arrangements” (11.6%). For school and district administrators, “availability of teacher resources to address social-emotional needs of a student” and “telecommunication and IT difficulty” were identified as substantial challenges. For schools remaining open throughout the COVID-19 pandemic, the most commonly reported challenges include “social distancing” (26.4%), “access to gymnasium/equipment” (23.1%), and “concern for personal health and wellbeing” (23.1%). In addition, the district administrators were concerned with “addressing parent/students concerns regarding the COVID-19 pandemic” (33.3%) (data not shown). Discussion To date, this is the first study to examine the impact of the COVID-19 pandemic on PE and physical activity in youth as reported by a national convenience sample of physical educators, school/district administrators, and others. We showed that during the pandemic, respondents reported that youth across the US spent less time in both PE and physical activity. This finding, coupled with the dramatic relaxation of PE requirements, suggests a substantial reduction in opportunities for physical activity in youth during the pandemic. Although no other research regarding PE during a pandemic exists, previous literature has clearly demonstrated the negative impact of extended breaks from school on the health of youth (Brusseau et al., 2019 ; Carrel, Clark, Peterson, Eickhoff, & Allen, 2007 ; Moreno et al., 2013 ). For example, Carrel et al.(Carrel et al., 2007 ) showed that in obese, middle-school children, a nine-month fitness-based PE intervention improved cardiorespiratory fitness, BMI, and insulin levels. Unfortunately, when the intervention was stopped during a 3-month summer break, all improvements were lost. This highlights the importance of ensuring continuation of PE and exercise during prolonged school breaks. Our survey discovered that a sizable percentage of respondents reported a reduction in or having no PE requirements during the pandemic. This “PE dumping” is likely multifaceted arising from acute health-related precautions, economic concerns, and the necessity to maintain academic programming. The pandemic did not only impact PE, but also played a role in the amount of physical activity and exercise undertaken by youth across the nation. The results showed that 78.8% of survey participants believed their students were obtaining either “significantly less” or “somewhat less” physical activity compared to their typical school day. These findings demonstrate the need for at-home resources and solutions, so that youth can continue engaging in physical activity despite stay-at-home orders. Our findings were consistent with that of Pietrobelli et al. ( 2020 ) who showed that, children and adolescents enrolled in a longitudinal observational study in Verona, Italy, decreased their time spent in sports by an average of 2.3 hours/week and increased their screen time by approximately 4.9 hours/week during the COVID-19 pandemic. Similar trends were observed in Shanghai, China among 2,426 youth who participated in the Global Physical Activity Questionnaire developed by the WHO (Xiang, Zhang, & Kuwahara, 2020 ). The authors found that the median time spent in physical activity decreased from 540 minutes/week to 105 minutes/week during the pandemic. Additionally, the prevalence of physically inactive youth increased from 21.3–65.6% during the same time period. Based on these findings, it is clear that opportunities for physical activity have decreased around the globe, and it is imperative that all youth are provided with safe, simple and easily implemented physical activity programs during the various phases of this pandemic (Chen et al., 2020 ). The ramifications of decreased physical activity, school closures, and social isolation extend beyond declines in physical health. Mental health, specifically anxiety, stress, and depression, are negatively impacted when school-based resources are removed, leading to a worsening of these conditions (Lee, 2020 ). As such, it is of utmost importance to support youth facing bereavement, parental unemployment, and drastic losses of household income. A possible method of improving mental health during the pandemic is to implement a structured exercise program that the child or adolescent finds enjoyable. Previous literature has shown that depressed adolescents treated with exercise were able to significantly reduce symptoms, improve psychosocial functioning, and maintain improvements at one-year follow up (Hughes et al., 2013 ). Finally, the findings of the present study identified and confirmed the substantial challenges experienced by teachers in both open and closed schools. While the concerns vary greatly between the two settings, this work provides great insight to educators and administrators for the upcoming school year. First, for schools that remained open, the PE curricular requirement was largely zero. This is not surprising as most of the US has been under social distancing orders, and as such, it is likely that schools removed activities where a student could break the “6 feet of separation” guideline and have to share exercise and/or sports equipment. For the schools that remained open, the biggest challenges were social distancing, access to a gymnasium, and concern for personal health and wellbeing. These challenges are especially important, as they should be utilized to inform educators and administrators returning to campus in the future. It will be critical to identify curriculum, activities, and equipment that allow youth to be physically active while avoiding close contact or use of uncleaned equipment. In the closed schools, the most frequent challenge experienced by teachers as well as school/district administrators during the pandemic was “student access to online learning.” Considering that 60.4% of the respondents were from Title 1 schools, it is possible that the resources to carry out virtual learning were not immediately available to a large percentage of students. It was reassuring to see that an emphasis was put on having at least 1 hour/week of PE in the at-home environment, which supports expert guidelines that everyone should remain physically active with appropriate precautions. Nonetheless, the general impression from the respondents was that there was a moderate to significant decrease in physical activity. This may be driven by economic, social, and environmental factors that prevent children from engaging in physical activity. If the pandemic continues, it will be critical to ensure that all children have access to physical activity motivating materials. A strength of this study is the inclusion of a national convenience sample of survey respondents across each of the 50 US states, including the District of Columbia and Puerto Rico. An important benefit of this study was that 60.4% of the respondents were from Title 1 schools, which is comparable to the reported 2015–2016 national average (Statistics, 2020 ). Another strength of the study was the ability to gather information from various sources within the educational hierarchy including but not limited to physical educators, district and school administrators, athletic directors, grade teachers, coaches and nurses. The individually reported data reflect the unique respondent’s personal experience of their school environment and curriculum. Additionally, data were collected in a limited time frame after most schools have been working remotely for at least a month, and in general, were unaware of plans for returning to school. Hence, the accuracy of the perceived experiences was likely high. A limitation of the study is the lack of a scientifically validated questionnaire for school-level information that would answer the proposed aims. However, face validity was considered. Another limitation of the study is that a single survey respondent answered the questions based on their perception of the school environment, which could lead to biased responses. However, most participants who completed the survey were physical educators and thus the local expert on the topic. Conclusion In conclusion, the study showed the impact of COVID-19 on PE and physical activity across the nation. Significant reductions were observed in requirements for PE as well as the amount of time engaged in physical activity. Both of these factors could lead to higher obesity and lower cardiorespiratory fitness among children, predisposing them to cardiometabolic disease and other health consequences. Additionally, the most significant challenges experienced by teachers during the pandemic were identified for both closed and open schools. These results clearly support that different measures must be taken to keep children active and fit based on their educational environment. Schools should continue to maintain a PE requirement as a critical educational component during the pandemic. For those schooling remotely, it is critical to prioritize online learning options in the school curriculum and provide access to physical activity promoting materials. A potential obstacle, particularly in Title 1 schools, is the availability of adults to assist in the remote education as parents may need to work. It will likely require a combination of school- and community-based leadership support to ensure that children have adult supervision for both academic and physical education. For those attending school, the issues are more complicated as activity must be integrated with the need for social distancing. Optimally, PE curriculum with outdoor activities and without shareable equipment would provide opportunity for PE and exercise. Future research should examine the optimal methods to teach in both environments considering current acute health issues, or Coronavirus, and long-term obesity and inactivity related concerns such as diabetes. Additionally, future work should focus on developing carefully crafted questionnaires that will provide optimal insight for longitudinal and post-COVID-19 studies. It must be emphasized that maintenance of physical education and activity needs to be highly prioritized in the school or district planning as a healthy child is known to be a better learner with less behavioral issues (Welk et al., 2010 ). Abbreviations BMI Body Mass Index PE Physical Education US United States WHO World Health Organization Declarations Ethics approval and consent to participate: We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. In so doing we confirm that we have followed the regulations of our institutions concerning intellectual property. We further confirm that any aspect of the work covered in this manuscript that has involved human participants has been conducted with the ethical approval of The Cooper Institute Scientific Review Board. All potential subjects were invited to participate via e-mail letter, and consented by clicking on a link that took them directly to the survey. By progressing to the survey, consent was implied. We understand that the Corresponding Author is the sole contact for the Editorial process (including Editorial Manager and direct communications with the office). She is responsible for communicating with the other authors about progress, submissions of revisions and final approval of proofs. We confirm that we have provided a current, correct email address which is accessible by the Corresponding Author. Consent for Publication: Not applicable. Availability of Data and Materials: The datasets during and/or analyzed during the current study available from the corresponding author on reasonable request. Competing Interest: We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. Funding: No funding sources to disclose. Author Contributions Conceived and designed the experiments: AP, LD, BN, ST, TW, DC, HK, WH Performed the experiments: AP, LD, BN, ST, TW, DC Analyzed and interpreted the data: AP, LD, BN, ST, TW, DC , GV, DL, HK, WH Wrote the paper: AP, LD, BN, ST, TW, DC, GV, DL, HK, WH All authors have read and approved the manuscript. Acknowledgements: The research team would like to thank Georgi Roberts, MS, Director of Health and Physical Education at Ft. Worth, TX Independent School District, for providing valuable feedback on the study and the survey. We are very grateful to Dr. Kenneth H. Cooper for his zealous efforts to ensure all youth have an opportunity to live a healthy and active life. Finally, we would like to thank Dr. Carolyn Barlow for her support in survey development and Ms. Julie Reed for providing administrative support. References Brusseau, T. A., Burns, R. D., Fu, Y., & Weaver, R. G. (2019). Impact of Year-Round and Traditional School Schedules on Summer Weight Gain and Fitness Loss. Child Obes, 15 (8), 541-547. doi:10.1089/chi.2019.0070 Carrel, A. L., Clark, R. R., Peterson, S., Eickhoff, J., & Allen, D. B. (2007). School-based fitness changes are lost during the summer vacation. Arch Pediatr Adolesc Med, 161 (6), 561-564. doi:10.1001/archpedi.161.6.561 Chen, P., Mao, L., Nassis, G. P., Harmer, P., Ainsworth, B. E., & Li, F. (2020). Coronavirus disease (COVID-19): The need to maintain regular physical activity while taking precautions. J Sport Health Sci, 9 (2), 103-104. doi:10.1016/j.jshs.2020.02.001 Hughes, C. W., Barnes, S., Barnes, C., Defina, L. F., Nakonezny, P., & Emslie, G. J. (2013). Depressed Adolescents Treated with Exercise (DATE): A pilot randomized controlled trial to test feasibility and establish preliminary effect sizes. Ment Health Phys Act, 6 (2). doi:10.1016/j.mhpa.2013.06.006 Lee, J. (2020). Mental health effects of school closures during COVID-19. Lancet Child Adolesc Health . doi:10.1016/S2352-4642(20)30109-7 Lewnard, J. A., & Lo, N. C. (2020). Scientific and ethical basis for social-distancing interventions against COVID-19. Lancet Infect Dis . doi:10.1016/S1473-3099(20)30190-0 Moreno, J. P., Johnston, C. A., & Woehler, D. (2013). Changes in weight over the school year and summer vacation: results of a 5-year longitudinal study. J Sch Health, 83 (7), 473-477. doi:10.1111/josh.12054 National Academies of Sciences, Engineering, and Medicine. 2019. Shaping Summertime Experiences: Opportunities to Promote Healthy Development and Well-Being for Children and Youth. Washington, DC: The National Academies Press. https://doi.org/10.17226/25546.Organization, W. H. (2020a). Be Active during COVID-19. Retrieved from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/be-active-during-covid-19 . Organization, W. H. (2020b). Coronavirus disease (COVID-19) Situation Dashboard. Retrieved from https://covid19.who.int/ Pietrobelli, A., Pecoraro, L., Ferruzzi, A., Heo, M., Faith, M., Zoller, T., . . . Heymsfield, S. B. (2020). Effects of COVID-19 Lockdown on Lifestyle Behaviors in Children with Obesity Living in Verona, Italy: A Longitudinal Study. Obesity (Silver Spring) . doi:10.1002/oby.22861 Statistics, N. C. f. E. (2020). Selected statistics from the public elementary and secondary education universe: School year 2015 – 2016. Retrieved from https://nces.ed.gov/pubs2018/2018052/tables/table_03.asp#f2 Stewart, H., Watson, N., & Campbell, M. (2018). The cost of school holidays for children from low income families. Childhood, 25 (4), 516-529. doi:10.1177/0907568218779130 Welk, G. J., Jackson, A. W., Morrow, J. R., Jr., Haskell, W. H., Meredith, M. D., & Cooper, K. H. (2010). The association of health-related fitness with indicators of academic performance in Texas schools. Res Q Exerc Sport, 81 (3 Suppl), S16-23. doi:10.1080/02701367.2010.10599690 Xiang, M., Zhang, Z., & Kuwahara, K. (2020). Impact of COVID-19 pandemic on children and adolescents' lifestyle behavior larger than expected. Prog Cardiovasc Dis . doi:10.1016/j.pcad.2020.04.013 Cite Share Download PDF Status: Published Journal Publication published 11 Mar, 2021 Read the published version in BMC Public Health → Version 1 posted Review # 3 received at journal 14 Feb, 2021 Review # 2 received at journal 14 Feb, 2021 Editorial decision: Minor revision 14 Feb, 2021 Review # 4 received at journal 10 Feb, 2021 Review # 1 received at journal 08 Feb, 2021 Reviewer # 6 agreed at journal 24 Jan, 2021 Reviewer # 5 agreed at journal 24 Jan, 2021 Reviewer # 4 agreed at journal 22 Jan, 2021 Reviewer # 3 agreed at journal 22 Jan, 2021 Reviewer # 2 agreed at journal 20 Jan, 2021 Reviewer # 1 agreed at journal 20 Jan, 2021 Reviewers invited by journal 06 Jan, 2021 Editor assigned by journal 05 Jan, 2021 Submission checks completed at journal 05 Jan, 2021 Editor invited by journal 05 Jan, 2021 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Vint","email":"","orcid":"","institution":"The Cooper Institute","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Georgina","middleName":"R.","lastName":"Vint","suffix":""},{"id":7726173,"identity":"91d017a2-d02c-4e6d-8c96-4da8e1462d98","order_by":7,"name":"David Leonard","email":"","orcid":"","institution":"The Cooper Institute","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"David","middleName":"","lastName":"Leonard","suffix":""},{"id":7726174,"identity":"d86dcb02-585c-4339-b014-b93bb4993c55","order_by":8,"name":"William L. Haskell","email":"","orcid":"","institution":"Stanford University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"William","middleName":"L.","lastName":"Haskell","suffix":""},{"id":7726175,"identity":"60f077a3-f4bd-42b2-b0b6-37dc1c391ea7","order_by":9,"name":"Harold W. Kohl III","email":"","orcid":"","institution":"University of Texas Austin","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Harold","middleName":"W. Kohl","lastName":"III","suffix":""}],"badges":[],"createdAt":"2021-01-07 12:17:52","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-142643/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-142643/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-021-10545-x","type":"published","date":"2021-03-11T15:00:28+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":4940070,"identity":"b5a44887-cce9-4b4a-b977-f00910d570db","added_by":"auto","created_at":"2021-01-13 21:59:35","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":60365,"visible":true,"origin":"","legend":"Physical Education requirements (hours/week) prior to versus during the COVID-19 pandemic based on school closure status (closed schools, left panel; open schools, right panel). ","description":"","filename":"Fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-142643/v1/484b3581300ec19f0ce66489.jpg"},{"id":4939980,"identity":"cef2e2c4-5188-435b-8879-11a5fc6b1769","added_by":"auto","created_at":"2021-01-13 21:53:35","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":53137,"visible":true,"origin":"","legend":"Survey respondent’s impression of the amount of physical activity accumulated during the school closure compared to the amount obtained in the typical school setting.","description":"","filename":"Fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-142643/v1/3addfe7f192c6aa83e419611.jpg"},{"id":4939982,"identity":"9166652c-79a2-465c-aea3-2518091e0ae7","added_by":"auto","created_at":"2021-01-13 21:53:35","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":61630,"visible":true,"origin":"","legend":"The survey respondents were asked to select the top three most significant challenges to teaching during the COVID-19 pandemic. A. Challenges experienced by closed schools. B. Challenges experiences by schools that remained open. ","description":"","filename":"Fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-142643/v1/f149cf8bffd1cd80f75f2ba2.jpg"},{"id":13645271,"identity":"64cb2d92-77ec-4974-befa-f78e86e80ffb","added_by":"auto","created_at":"2021-09-17 09:19:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":408791,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-142643/v1/769ae3ac-4fbd-4bdc-b9c1-798fa1280259.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eKeeping Children Healthy During and After COVID-19 Pandemic: Meeting Youth Physical Activity Needs\u003c/p\u003e","fulltext":[{"header":"Background","content":" \u003cp\u003eIn December 2019, a cluster of pneumonia like cases began to appear in China caused by a previously unknown virus, \u003cem\u003eSARS-CoV-2\u003c/em\u003e. The known cases of disease caused by this virus (COVID-19) grew at an exponential rate causing the World Health Organization (WHO) to declare COVID-19 a pandemic in March 2020. By early September, approximately 25.6\u0026nbsp;million confirmed cases were diagnosed worldwide with over 850,000 deaths across more than 200 countries (Organization, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020b\u003c/span\u003e). The pandemic nature of COVID-19 led to extraordinary societal measures aimed at containing the virus including closure of schools, social distancing, and sheltering in place at home across the United States (US) (Lewnard \u0026amp; Lo, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe impact of prolonged school closures on students undergoing \u0026ldquo;distance learning\u0026rdquo; for a pandemic is unknown. During extended breaks from schools, such as summertime, there are significant challenges including \u0026ldquo;summer learning loss\u0026rdquo; which reflects not only stagnation of learned information but also regression. From an academic perspective, the loss is greater in spelling skills and math computation than reading (Stewart, Watson, \u0026amp; Campbell, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). These losses are more pronounced among children with low socioeconomic status, learning disabilities, and for whom English is a second language (National Academies of Sciences et al., 2019).\u003c/p\u003e \u003cp\u003eIn addition to academics, children\u0026rsquo;s health suffers during these breaks as body mass index (BMI) is known to increase during the summer as much as 5.2 percentile points in one study evaluating 3,588 ethnically diverse children (Moreno, Johnston, \u0026amp; Woehler, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). A smaller study evaluating the impact of break duration on weight showed that shorter breaks (3 and 7 weeks) mitigated increases in BMI versus 12-week breaks. Finally, children who participated in organized summer sports had significant improvement in their cardiovascular fitness compared to non-participants (Brusseau, Burns, Fu, \u0026amp; Weaver, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The current norm of distance learning, born out of necessity for social distancing, will likely have parallel effects. Given the known, negative impact of extended school breaks on youth health, it is critical to understand how current remote schooling affects physical activity levels of children.\u003c/p\u003e \u003cp\u003eMany schools and school districts are faced with the challenge of finding the best approaches to deliver distance education including Physical Education (PE). While basic subjects such as math, science and English adapt well to distance learning, less is known about PE. Additionally, social distancing and sheltering at home may decrease opportunities for physical activity. Experts continue to emphasize the importance of a physically active lifestyle for health and stress management, assuming appropriate precautions (Organization, 2020a). The purpose of the current study was to 1) examine the maintenance of PE and physical activity during the distance learning time, 2) determine the resources educators are utilizing to deliver PE curriculum, and 3) understand the challenges experienced by physical educators during distance learning.\u003c/p\u003e "},{"header":"Methods","content":" \u003cp\u003eThe \u0026ldquo;Meeting Children\u0026rsquo;s Physical Activity Needs during the COVID-19 Pandemic\u0026rdquo; questionnaire was developed to focus on three domains: 1) descriptive characteristics (job title of survey respondent, school location, school/district type and classification, and Title 1 status), 2) access to PE and physical activity, and 3) challenges associated with delivering PE and physical activity during the pandemic. To address these aims, the authors developed a new questionnaire. In general, closed-ended response format was used to allow for efficient data aggregation and analysis. Further, emphasis was placed on limiting the number of questions for ease of administration while still capturing adequate information. The face validity was assessed by experts in the field. The questionnaire was then entered into Qualtrics XM\u0026reg; (SAP America Inc., Philadelphia, PA). Pretesting was accomplished by three experienced researchers with subject matter expertise.\u003c/p\u003e \u003cp\u003eThe target population was selected from individuals with available email addresses within a single fitness assessment software (FitnessGram\u0026reg;), a tool to collect school-based fitness assessment data on children grades 3 to 12. This tool is widely used in the US and allowed for a diverse sample of respondents in terms of socioeconomics, regions, and states. Each survey participant answered a maximum of 15 questions based on their institution\u0026rsquo;s educational environment. FitnessGram users consist predominantly of PE teachers and school/district administrators including current or previous participants in The Cooper Institute Youth Programs (NFL Play 60 FitnessGram Project and the Healthy Zone\u0026trade; School Program).\u003c/p\u003e \u003cp\u003eOn April 23rd, 2020, the questionnaire was distributed to a convenience sample of 60,198 email contacts in the fitness assessment software contact database representing 29,786 active users and 30,412 prior users. Within the active contacts, 6,839 schools were represented. The prevalence of viable and current email addresses in this database is unknown, making a definitive response rate unclear. In order to enhance response, four reminder emails were sent at approximately two day intervals and a giftcard raffle incentive was offered to participants. The deadline for completing the survey was May 4th, 2020\u0026nbsp;at 11:59 PM. A one-week response time was chosen at the guidance of school administration and to ensure availability of results well before fall planning. Ultimately, 3,159 individuals responded to the survey. Of those, 594 individuals provided no answers and 125 provided partial demographic information, but answered no study-related questions. This resulted in a final analytic sample of 2,440.\u003c/p\u003e \u003cp\u003eAn introductory e-mail was sent to potential participants with study information, including the voluntary nature, and informed consent was implied when the respondent actively initiated the questionnaire. No identifying information was utilized in the study analysis. The research project and methodology were approved by The Cooper Institute Scientific and Institutional Review Boards.\u003c/p\u003e \u003cp\u003eResponses were exported from the Qualtrics XM\u0026reg; online survey platform and analyzed in SAS/STAT\u0026reg;, version 9.4 (SAS Institute, Inc. Cary NC USA). Descriptive statistics on respondent locations, job titles and school classification and status were tabulated along with selected responses on PE requirements and delivery before and during the pandemic. Changes in hours of PE required before and during the pandemic were tested using rank-sum statistics. The trend in responses across a Likert scale of accumulated physical activity changes among respondents whose school was closed was based on a model of log-linear counts. We considered each respondent as an independent observation, taking the view that respondents answered according to their own experiences, not as agents of a particular school or district.\u003c/p\u003e "},{"header":"Results","content":" \u003cp\u003eDescriptive characteristics of respondents are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The majority of respondents were PE teachers (n\u0026thinsp;=\u0026thinsp;1,789), followed by district (n\u0026thinsp;=\u0026thinsp;64) and school (n\u0026thinsp;=\u0026thinsp;62) administrators, and nurses (n\u0026thinsp;=\u0026thinsp;3). An additional 522 survey respondents chose the \u0026ldquo;other\u0026rdquo; category, which consisted of classroom teachers, coaches, PE department chairs, athletic directors, and information technology personnel. The final sample of respondents had representation from each of the 50 US states, the District of Columbia and Puerto Rico. Additionally, 41 participants reported residing outside of the US. Overall, we saw little regional variation in the results. The greatest number of participants were from a city or suburb (69.7%), elementary or middle school (72.3%), and had Title 1 status, an indicator of low socioeconomic status, (60.4%). The vast majority of respondents reported their campus being closed during the COVID-19 pandemic (97.8%) with 97.4% of school closures occurring during the month of March 2020.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive characteristics of survey respondents.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJob Title (n)\u003c/p\u003e \u003cp\u003e- Physical Education Teacher\u003c/p\u003e \u003cp\u003e- District Administrator\u003c/p\u003e \u003cp\u003e- School Administrator\u003c/p\u003e \u003cp\u003e- Nurse\u003c/p\u003e \u003cp\u003e- Other\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,440\u003c/p\u003e \u003cp\u003e1,789 (73.3)\u003c/p\u003e \u003cp\u003e64 (2.6)\u003c/p\u003e \u003cp\u003e62 (2.5)\u003c/p\u003e \u003cp\u003e3 (0.1)\u003c/p\u003e \u003cp\u003e522 (21.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchool/District Type\u003c/p\u003e \u003cp\u003e- City\u003c/p\u003e \u003cp\u003e- Suburb\u003c/p\u003e \u003cp\u003e- Town\u003c/p\u003e \u003cp\u003e- Rural\u003c/p\u003e \u003cp\u003e- I don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,440\u003c/p\u003e \u003cp\u003e896 (36.7)\u003c/p\u003e \u003cp\u003e806 (33)\u003c/p\u003e \u003cp\u003e385 (15.8)\u003c/p\u003e \u003cp\u003e315 (12.9)\u003c/p\u003e \u003cp\u003e38 (1.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchool Classification\u003c/p\u003e \u003cp\u003e- Elementary\u003c/p\u003e \u003cp\u003e- Middle\u003c/p\u003e \u003cp\u003e- High\u003c/p\u003e \u003cp\u003e- Other\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,846\u003c/p\u003e \u003cp\u003e809 (43.8)\u003c/p\u003e \u003cp\u003e526 (28.5)\u003c/p\u003e \u003cp\u003e369 (20)\u003c/p\u003e \u003cp\u003e142 (7.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTitle 1 Status\u003c/p\u003e \u003cp\u003e- Yes\u003c/p\u003e \u003cp\u003e- No\u003c/p\u003e \u003cp\u003e- I don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1846\u003c/p\u003e \u003cp\u003e1114 (60.4)\u003c/p\u003e \u003cp\u003e614 (33.3)\u003c/p\u003e \u003cp\u003e118 (6.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnited States Regional Breakdown\u003c/p\u003e \u003cp\u003e- Midwest\u003c/p\u003e \u003cp\u003e- Northeast\u003c/p\u003e \u003cp\u003e- South\u003c/p\u003e \u003cp\u003e- West\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,424\u003c/p\u003e \u003cp\u003e603 (24.7)\u003c/p\u003e \u003cp\u003e242 (9.9)\u003c/p\u003e \u003cp\u003e1238 (50.7)\u003c/p\u003e \u003cp\u003e314 (12.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClosed During the Pandemic\u003c/p\u003e \u003cp\u003e- Yes\u003c/p\u003e \u003cp\u003e- No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2432\u003c/p\u003e \u003cp\u003e2379 (97.8)\u003c/p\u003e \u003cp\u003e53 (2.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClosure Month\u003c/p\u003e \u003cp\u003e- Prior to March 2020\u003c/p\u003e \u003cp\u003e- March 2020\u003c/p\u003e \u003cp\u003e- April 2020\u003c/p\u003e \u003cp\u003e- May 2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2340\u003c/p\u003e \u003cp\u003e15 (0.6)\u003c/p\u003e \u003cp\u003e2281 (97.4)\u003c/p\u003e \u003cp\u003e40 (1.7)\u003c/p\u003e \u003cp\u003e4 (0.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSurvey participants were asked if their school had access to distance learning prior to the COVID-19 pandemic. The largest percentage of respondents reported either \u0026ldquo;no access\u0026rdquo; (19.7%) or \u0026ldquo;I don\u0026rsquo;t know\u0026rdquo; (18.9%) to the availability of distance learning. For those schools with a distance learning infrastructure, math and science were most commonly available at 19.5% and 17.4%, respectively. Health and PE lagged behind with 12.3% and 12.1% identifying these subjects as part of distance learning prior to the COVID-19 pandemic. For those schools that closed their campuses, 86.1% were reportedly able to deliver PE remotely. The preferred methods of delivering such PE curricula were via distance learning (47.7%), at-home resources (26.6%), and parent collaboration (15.3%).\u003c/p\u003e \u003cp\u003ePrior to the COVID-19 pandemic, only 2.8% and 7.7% of pandemic closed and open schools, respectively, had no PE requirements (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The most common mandatory PE time was 1\u0026ndash;2 hours/week. During the pandemic, the percentage of schools with no PE requirement increased for both closed (21%) and open schools (60.5%). Furthermore, the total closed schools requiring at least 1 hour of PE/week increased and the percentage of 3 and \u0026ge;\u0026thinsp;4 required hours/week decreased. Overall, the survey results show that mandatory PE was maintained in the closed schools to a larger degree than open schools.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn addition to the PE related questions, we sought to determine the amount of physical activity and exercise obtained by students following the onset of the pandemic compared to the amount in a typical school day. Nearly 79% of survey respondents reported that students were accumulating either \u0026ldquo;significantly less\u0026rdquo; or \u0026ldquo;somewhat less\u0026rdquo; activity during the closure (Fig.\u0026nbsp;2). Respondents from Title 1 schools reported less physical activity for students during the shut-down than respondents from non-Title 1 schools or respondents unaware of their school\u0026rsquo;s Title 1 standing (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). When able to deliver physical activity, the most commonly cited methods included at-home resources such as GoNoodle, OPEN, or YouTube (29%), e-learning platforms (27.9%), or virtual fitness/workouts by PE teachers (25.6%).\u003c/p\u003e \u003cp\u003eFinally, the survey addressed the challenges experienced by teachers delivering PE in both closed (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e, A.) and open (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e, B.) schools. For schools \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eclosed\u003c/span\u003e during the pandemic, the three most frequently cited challenges included \u0026ldquo;student access to online learning\u0026rdquo; (23.3%), \u0026ldquo;teacher/student communication\u0026rdquo; (14.3%), and \u0026ldquo;teacher remote work arrangements\u0026rdquo; (11.6%). For school and district administrators, \u0026ldquo;availability of teacher resources to address social-emotional needs of a student\u0026rdquo; and \u0026ldquo;telecommunication and IT difficulty\u0026rdquo; were identified as substantial challenges. For schools remaining \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eopen\u003c/span\u003e throughout the COVID-19 pandemic, the most commonly reported challenges include \u0026ldquo;social distancing\u0026rdquo; (26.4%), \u0026ldquo;access to gymnasium/equipment\u0026rdquo; (23.1%), and \u0026ldquo;concern for personal health and wellbeing\u0026rdquo; (23.1%). In addition, the district administrators were concerned with \u0026ldquo;addressing parent/students concerns regarding the COVID-19 pandemic\u0026rdquo; (33.3%) (data not shown).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e "},{"header":"Discussion","content":" \u003cp\u003eTo date, this is the first study to examine the impact of the COVID-19 pandemic on PE and physical activity in youth as reported by a national convenience sample of physical educators, school/district administrators, and others. We showed that during the pandemic, respondents reported that youth across the US spent less time in both PE and physical activity. This finding, coupled with the dramatic relaxation of PE requirements, suggests a substantial reduction in opportunities for physical activity in youth during the pandemic. Although no other research regarding PE during a pandemic exists, previous literature has clearly demonstrated the negative impact of extended breaks from school on the health of youth (Brusseau et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Carrel, Clark, Peterson, Eickhoff, \u0026amp; Allen, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Moreno et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). For example, Carrel et al.(Carrel et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2007\u003c/span\u003e) showed that in obese, middle-school children, a nine-month fitness-based PE intervention improved cardiorespiratory fitness, BMI, and insulin levels. Unfortunately, when the intervention was stopped during a 3-month summer break, all improvements were lost. This highlights the importance of ensuring continuation of PE and exercise during prolonged school breaks. Our survey discovered that a sizable percentage of respondents reported a reduction in or having no PE requirements during the pandemic. This \u0026ldquo;PE dumping\u0026rdquo; is likely multifaceted arising from acute health-related precautions, economic concerns, and the necessity to maintain academic programming.\u003c/p\u003e \u003cp\u003eThe pandemic did not only impact PE, but also played a role in the amount of physical activity and exercise undertaken by youth across the nation. The results showed that 78.8% of survey participants believed their students were obtaining either \u0026ldquo;significantly less\u0026rdquo; or \u0026ldquo;somewhat less\u0026rdquo; physical activity compared to their typical school day. These findings demonstrate the need for at-home resources and solutions, so that youth can continue engaging in physical activity despite stay-at-home orders. Our findings were consistent with that of Pietrobelli et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) who showed that, children and adolescents enrolled in a longitudinal observational study in Verona, Italy, decreased their time spent in sports by an average of 2.3 hours/week and increased their screen time by approximately 4.9 hours/week during the COVID-19 pandemic. Similar trends were observed in Shanghai, China among 2,426 youth who participated in the Global Physical Activity Questionnaire developed by the WHO (Xiang, Zhang, \u0026amp; Kuwahara, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The authors found that the median time spent in physical activity decreased from 540 minutes/week to 105 minutes/week during the pandemic. Additionally, the prevalence of physically inactive youth increased from 21.3\u0026ndash;65.6% during the same time period. Based on these findings, it is clear that opportunities for physical activity have decreased around the globe, and it is imperative that all youth are provided with safe, simple and easily implemented physical activity programs during the various phases of this pandemic (Chen et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe ramifications of decreased physical activity, school closures, and social isolation extend beyond declines in physical health. Mental health, specifically anxiety, stress, and depression, are negatively impacted when school-based resources are removed, leading to a worsening of these conditions (Lee, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). As such, it is of utmost importance to support youth facing bereavement, parental unemployment, and drastic losses of household income. A possible method of improving mental health during the pandemic is to implement a structured exercise program that the child or adolescent finds enjoyable. Previous literature has shown that depressed adolescents treated with exercise were able to significantly reduce symptoms, improve psychosocial functioning, and maintain improvements at one-year follow up (Hughes et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFinally, the findings of the present study identified and confirmed the substantial challenges experienced by teachers in both open and closed schools. While the concerns vary greatly between the two settings, this work provides great insight to educators and administrators for the upcoming school year. First, for schools that remained open, the PE curricular requirement was largely zero. This is not surprising as most of the US has been under social distancing orders, and as such, it is likely that schools removed activities where a student could break the \u0026ldquo;6 feet of separation\u0026rdquo; guideline and have to share exercise and/or sports equipment. For the schools that remained open, the biggest challenges were social distancing, access to a gymnasium, and concern for personal health and wellbeing. These challenges are especially important, as they should be utilized to inform educators and administrators returning to campus in the future. It will be critical to identify curriculum, activities, and equipment that allow youth to be physically active while avoiding close contact or use of uncleaned equipment.\u003c/p\u003e \u003cp\u003eIn the closed schools, the most frequent challenge experienced by teachers as well as school/district administrators during the pandemic was \u0026ldquo;student access to online learning.\u0026rdquo; Considering that 60.4% of the respondents were from Title 1 schools, it is possible that the resources to carry out virtual learning were not immediately available to a large percentage of students. It was reassuring to see that an emphasis was put on having at least 1 hour/week of PE in the at-home environment, which supports expert guidelines that everyone should remain physically active with appropriate precautions. Nonetheless, the general impression from the respondents was that there was a moderate to significant decrease in physical activity. This may be driven by economic, social, and environmental factors that prevent children from engaging in physical activity. If the pandemic continues, it will be critical to ensure that all children have access to physical activity motivating materials.\u003c/p\u003e \u003cp\u003eA strength of this study is the inclusion of a national convenience sample of survey respondents across each of the 50 US states, including the District of Columbia and Puerto Rico. An important benefit of this study was that 60.4% of the respondents were from Title 1 schools, which is comparable to the reported 2015\u0026ndash;2016 national average (Statistics, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Another strength of the study was the ability to gather information from various sources within the educational hierarchy including but not limited to physical educators, district and school administrators, athletic directors, grade teachers, coaches and nurses. The individually reported data reflect the unique respondent\u0026rsquo;s personal experience of their school environment and curriculum. Additionally, data were collected in a limited time frame after most schools have been working remotely for at least a month, and in general, were unaware of plans for returning to school. Hence, the accuracy of the perceived experiences was likely high. A limitation of the study is the lack of a scientifically validated questionnaire for school-level information that would answer the proposed aims. However, face validity was considered. Another limitation of the study is that a single survey respondent answered the questions based on their perception of the school environment, which could lead to biased responses. However, most participants who completed the survey were physical educators and thus the local expert on the topic.\u003c/p\u003e "},{"header":"Conclusion","content":" \u003cp\u003eIn conclusion, the study showed the impact of COVID-19 on PE and physical activity across the nation. Significant reductions were observed in requirements for PE as well as the amount of time engaged in physical activity. Both of these factors could lead to higher obesity and lower cardiorespiratory fitness among children, predisposing them to cardiometabolic disease and other health consequences. Additionally, the most significant challenges experienced by teachers during the pandemic were identified for both closed and open schools. These results clearly support that different measures must be taken to keep children active and fit based on their educational environment. Schools should continue to maintain a PE requirement as a critical educational component during the pandemic. For those schooling remotely, it is critical to prioritize online learning options in the school curriculum and provide access to physical activity promoting materials. A potential obstacle, particularly in Title 1 schools, is the availability of adults to assist in the remote education as parents may need to work. It will likely require a combination of school- and community-based leadership support to ensure that children have adult supervision for both academic and physical education. For those attending school, the issues are more complicated as activity must be integrated with the need for social distancing. Optimally, PE curriculum with outdoor activities and without shareable equipment would provide opportunity for PE and exercise. Future research should examine the optimal methods to teach in both environments considering current acute health issues, or Coronavirus, and long-term obesity and inactivity related concerns such as diabetes. Additionally, future work should focus on developing carefully crafted questionnaires that will provide optimal insight for longitudinal and post-COVID-19 studies. It must be emphasized that maintenance of physical education and activity needs to be highly prioritized in the school or district planning as a healthy child is known to be a better learner with less behavioral issues (Welk et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2010\u003c/span\u003e).\u003c/p\u003e "},{"header":"Abbreviations","content":" \u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody Mass Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePhysical Education\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUnited States\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. In so doing we confirm that we have followed the regulations of our institutions concerning intellectual property. We further confirm that any aspect of the work covered in this manuscript that has involved human participants has been conducted with the ethical approval of The Cooper Institute Scientific Review Board. All potential subjects were invited to participate via e-mail letter, and consented by clicking on a link that took them directly to the survey. By progressing to the survey, consent was implied.\u003c/p\u003e\n\u003cp\u003eWe understand that the Corresponding Author is the sole contact for the Editorial process (including Editorial Manager and direct communications with the office). She is responsible for communicating with the other authors about progress, submissions of revisions and final approval of proofs. We confirm that we have provided a current, correct email address which is accessible by the Corresponding Author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets during and/or analyzed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding: \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding sources to disclose.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions \u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003eConceived and designed the experiments: AP, LD, BN, ST, TW, DC, HK, WH\u003c/li\u003e\n\u003cli\u003ePerformed the experiments: AP, LD, BN, ST, TW, DC\u003c/li\u003e\n\u003cli\u003eAnalyzed and interpreted the data: AP, LD, BN, ST, TW, DC , GV, DL, HK, WH\u003c/li\u003e\n\u003cli\u003eWrote the paper: AP, LD, BN, ST, TW, DC, GV, DL, HK, WH\u003c/li\u003e\n\u003cli\u003eAll authors have read and approved the manuscript.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research team would like to thank Georgi Roberts, MS, Director of Health and Physical Education at Ft. Worth, TX Independent School District, for providing valuable feedback on the study and the survey. We are very grateful to Dr. Kenneth H. Cooper for his zealous efforts to ensure all youth have an opportunity to live a healthy and active life. Finally, we would like to thank Dr. Carolyn Barlow for her support in survey development and Ms. Julie Reed for providing administrative support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBrusseau, T. A., Burns, R. D., Fu, Y., \u0026amp; Weaver, R. G. (2019). Impact of Year-Round and Traditional School Schedules on Summer Weight Gain and Fitness Loss. \u003cem\u003eChild Obes, 15\u003c/em\u003e(8), 541-547. doi:10.1089/chi.2019.0070\u003c/li\u003e\n\u003cli\u003eCarrel, A. L., Clark, R. R., Peterson, S., Eickhoff, J., \u0026amp; Allen, D. B. (2007). School-based fitness changes are lost during the summer vacation. \u003cem\u003eArch Pediatr Adolesc Med, 161\u003c/em\u003e(6), 561-564. doi:10.1001/archpedi.161.6.561\u003c/li\u003e\n\u003cli\u003eChen, P., Mao, L., Nassis, G. P., Harmer, P., Ainsworth, B. E., \u0026amp; Li, F. (2020). Coronavirus disease (COVID-19): The need to maintain regular physical activity while taking precautions. \u003cem\u003eJ Sport Health Sci, 9\u003c/em\u003e(2), 103-104. doi:10.1016/j.jshs.2020.02.001\u003c/li\u003e\n\u003cli\u003eHughes, C. W., Barnes, S., Barnes, C., Defina, L. F., Nakonezny, P., \u0026amp; Emslie, G. J. (2013). Depressed Adolescents Treated with Exercise (DATE): A pilot randomized controlled trial to test feasibility and establish preliminary effect sizes. \u003cem\u003eMent Health Phys Act, 6\u003c/em\u003e(2). doi:10.1016/j.mhpa.2013.06.006\u003c/li\u003e\n\u003cli\u003eLee, J. (2020). Mental health effects of school closures during COVID-19. \u003cem\u003eLancet Child Adolesc Health\u003c/em\u003e. doi:10.1016/S2352-4642(20)30109-7\u003c/li\u003e\n\u003cli\u003eLewnard, J. A., \u0026amp; Lo, N. C. (2020). Scientific and ethical basis for social-distancing interventions against COVID-19. \u003cem\u003eLancet Infect Dis\u003c/em\u003e. doi:10.1016/S1473-3099(20)30190-0\u003c/li\u003e\n\u003cli\u003eMoreno, J. P., Johnston, C. A., \u0026amp; Woehler, D. (2013). Changes in weight over the school year and summer vacation: results of a 5-year longitudinal study. \u003cem\u003eJ Sch Health, 83\u003c/em\u003e(7), 473-477. doi:10.1111/josh.12054\u003c/li\u003e\n\u003cli\u003eNational Academies of Sciences, Engineering, and Medicine. 2019. Shaping Summertime Experiences: Opportunities to Promote Healthy Development and Well-Being for Children and Youth. Washington, DC: The National Academies Press. https://doi.org/10.17226/25546.Organization, W. H. (2020a). Be Active during COVID-19. Retrieved from \u003ca href=\"https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/be-active-during-covid-19\"\u003ehttps://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/be-active-during-covid-19\u003c/a\u003e.\u003c/li\u003e\n\u003cli\u003eOrganization, W. H. (2020b). Coronavirus disease (COVID-19) Situation Dashboard. Retrieved from \u003ca href=\"https://covid19.who.int/\"\u003ehttps://covid19.who.int/\u003c/a\u003e\u003c/li\u003e\n\u003cli\u003ePietrobelli, A., Pecoraro, L., Ferruzzi, A., Heo, M., Faith, M., Zoller, T., . . . Heymsfield, S. B. (2020). Effects of COVID-19 Lockdown on Lifestyle Behaviors in Children with Obesity Living in Verona, Italy: A Longitudinal Study. \u003cem\u003eObesity (Silver Spring)\u003c/em\u003e. doi:10.1002/oby.22861\u003c/li\u003e\n\u003cli\u003eStatistics, N. C. f. E. (2020). Selected statistics from the public elementary and secondary education universe: School year 2015 \u0026ndash; 2016. Retrieved from \u003ca href=\"https://nces.ed.gov/pubs2018/2018052/tables/table_03.asp#f2\"\u003ehttps://nces.ed.gov/pubs2018/2018052/tables/table_03.asp#f2\u003c/a\u003e\u003c/li\u003e\n\u003cli\u003eStewart, H., Watson, N., \u0026amp; Campbell, M. (2018). The cost of school holidays for children from low income families. \u003cem\u003eChildhood, 25\u003c/em\u003e(4), 516-529. doi:10.1177/0907568218779130\u003c/li\u003e\n\u003cli\u003eWelk, G. J., Jackson, A. W., Morrow, J. R., Jr., Haskell, W. H., Meredith, M. D., \u0026amp; Cooper, K. H. (2010). The association of health-related fitness with indicators of academic performance in Texas schools. \u003cem\u003eRes Q Exerc Sport, 81\u003c/em\u003e(3 Suppl), S16-23. doi:10.1080/02701367.2010.10599690\u003c/li\u003e\n\u003cli\u003eXiang, M., Zhang, Z., \u0026amp; Kuwahara, K. (2020). Impact of COVID-19 pandemic on children and adolescents' lifestyle behavior larger than expected. \u003cem\u003eProg Cardiovasc Dis\u003c/em\u003e. doi:10.1016/j.pcad.2020.04.013\u003c/li\u003e\n\u003c/ol\u003e "}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"physical education, physical activity, pandemic","lastPublishedDoi":"10.21203/rs.3.rs-142643/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-142643/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e The purpose of this study was to: 1) examine the maintenance of Physical Education and physical activity during the distance learning time, 2) determine the resources educators are utilizing to deliver PE curricula, and 3) understand the challenges experienced by educators during distance learning.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A survey was sent to a cohort of school-based fitness assessment software users. Respondents were largely school-based individuals including PE teachers (n= 1,789), school (n=62), and district administrators (n=64). nurses (n=3), and “other” (n =522). \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Of 2,440 respondents, most were from a city or suburb (69.7%), elementary or middle school (72.3%), and had Title 1 status, an indicator of low socioeconomic status, (60.4%). Most campuses were closed during the COVID-19 pandemic (97.8%). Of the schools closed during the pandemic, only 2.8% had no prior PE requirements and that increased to 21% during the pandemic. In schools that remained open during the pandemic, 7.7% had no prior PE requirements and this increased to 60.5%. Importantly, 79% of respondents reported that students were either “significantly less” or “somewhat less” physically active during the closure. For \u003cu\u003eclosed\u003c/u\u003e schools, the most frequently cited challenges included “student access to online learning“, “teacher/student communication” and “teacher remote work arrangements”. For\u003cu\u003e open\u003c/u\u003e schools, the most commonly reported challenges included “social distancing”, “access to gymnasium/equipment”, and “concern for personal health and wellbeing”.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion:\u0026nbsp;\u003c/strong\u003eThe COVID-19 pandemic has caused important reductions in PE requirements and time engaged in physical activity. Challenges experienced by teachers were identified for closed and open schools.\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Keeping Children Healthy During and After COVID-19 Pandemic: Meeting Youth Physical Activity Needs","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-01-13 21:53:33","doi":"10.21203/rs.3.rs-142643/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2021-02-15T00:00:00+00:00","index":3,"fulltext":"Recommendation: Accept after discretionary revisions\nForm responses:\n---\n\nComments to Author:\n---\nThis is a timely research project on an important issue - physical activity opportunities for children and youth at a time when they would especially benefit from movement opportunities. I have only a few minor editorial tweaks to recommend - see below. My only more significant comment is that I believe the authors should acknowledge the comparably small sample size of the open schools compared to the closed schools. Making generalizations based on the results of the closed skills makes good sense, making generalizations based on the small number of open skills requires more caution - this would be severely influenced by the Covid-19 case count in the particular area as well.\n\np. 2 l. 24 \"(n=62), and district administrators\" delete the comma \"(n=64). nurses\" replace the period with a comma\np. 2 l. 29 change to: and had Title 1 status (60.4%), an indicator of low socioeconomic status.\np. 4 l. 42 change to an additional language. [They may in fact speak several other languages that come before English.]\np. 5 l. 15 -17 \"While basic subjects such as math, science and English adapt well to distance learning, less is known about PE.\" support this statement with a reference. Do they adapt well? I suspect there are still many challenges particularly in the elementary cohort. l. 27 add colon \"study was to: 1) examine the maintenance of PE\"\np. 6 l. 4-6 \"Pretesting was accomplished by three experienced researchers with subject matter expertise.\" How was this done? Were any changes made to the measurement tool as a result of the pilot testing? Do the authors mean pretesting (implying the participants responded more than once) or pilot testing?\np. 10 l. 7-9 \"Carrel et al. (2007)\" delete author's name from parentheses. l. 44 change to \"showed that children and adolescents, enrolled in a longitudinal...\"\n\n\n\n\n\n\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **Yes**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **Yes**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"editorInvitedReview","content":"","date":"2021-02-15T00:00:00+00:00","index":2,"fulltext":"Recommendation: Major revisions required\nForm responses:\n---\n\nComments to Author:\n---\nIn the paper \"Keeping Children Healthy During and After COVID-19 Pandemic: Meeting Youth Physical Activity Needs\", the authors present interesting aspects related with the perception abut PE during COVID Pandemic. The results give information about the challenges afront by PE teachers and their perception about PA developed by children. Although the data that is presented can be quite useful for researchers, some major reviews must be done for its publication.\n\nMajor Review\n- Attending to the methodology of your research, it is no correct to stablish as a conclusion a reduction on PE levels in US children, according that you only have a perception of people who be in contact with them, but you don´t asses objectively (by accelerometers or something similar) the PA developed during pandemic confinement period. For that reason, you must adapt the whole paper taking that issue into account, especially in tittle, results, discussion, and conclusion.\n- If your research is focused on PE, you do not have to include surveys completed by people who are not PE teacher, because you are asking about issues that only a PE teacher have the real perception to answer about (challenges experienced for example).\n- It is convenient to add some new statistics, in order to add information about differences not only between open and closed schools, but also comparing school classification, school district, Tittle 1 status or US Region.\n- Attending to the changes proposed, you must change the discussion and conclusion in order to adapt it to the new results obtained.\n- It is advisable to add new tables and figures related to the new statistical approach.\n- You must include in limitations, that the % of closed schools is so low, not allowing to obtain significant results to compare with open schools.\n\n* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **No**\n* Declaration of competing interests: **I declare that I have no competing interests**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. (default)**\n* Is the study design appropriate to answer the research question (including the use of appropriate controls), and are the conclusions supported by the evidence presented?: **No**\n* Are the methods sufficiently described to allow the study to be repeated?: **Yes**\n* Is the use of statistics and treatment of uncertainties appropriate?: **No**\n* Is the presentation of the work clear?: **Yes**\n* Are the images in this manuscript (including electrophoretic gels and blots) free from apparent manipulation?: **Yes**\n"},{"type":"decision","content":"Minor revision","date":"2021-02-15T00:00:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-02-11T00:00:00+00:00","index":4,"fulltext":"Recommendation: Reviewer's comments unavailable pending editorial decision\n"},{"type":"editorInvitedReview","content":"","date":"2021-02-09T00:00:00+00:00","index":1,"fulltext":"Recommendation: Accept after discretionary revisions\nForm responses:\n---\n\nComments to Author:\n---\nThis survey was done to identify the lack of physical education and physical activity that students have been receiving or participating in for a specified period during the current pandemic in the United States. The survey adds to the existing body of literature that is identifying a decrease in physical activity participation during the current pandemic. One other limitation that the authors could consider adding to the discussion is the subjective nature of the survey they used as opposed to objectively measured physical activity participation by such tools as accelerometers.* Publons Reviewer Recognition. Springer Nature can send verification of this review directly to Publons (a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal, and date of your review submission (the “Review Data”) will then be transmitted to Publons upon publication of the manuscript. If you have already registered at Publons, they will notify you of the receipt of this review and update your profile as per your settings and their policy. If you are not registered with Publons, you will receive an email from them asking you to register in order for them to be able to recognize your review on your new profile page. Publons may use the Review Data to generate derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity of such information. For example, Publons may verify your record as a reviewer by updating your profile published on its webservice if you have registered for such service or help editors to identify candidate reviewers. Please find the details of processing in Publons’ privacy policy https://publons.com/about/terms: **Yes**\n* Declaration of competing interests: **I declare that I have no competing interests.**\n* Reviewer Publication Consent. I agree for my report to be made available under an Open Access Creative Commons CC-BY License (http://creativecommons.org/licenses/by/4.0) if this manuscript is accepted for publication. Any comments that I do not wish to be included in the published report have been included as confidential comments to the editor, which will not be published.: **I agree to the terms of the CC-BY 4.0 license; please do not publish my name with my report. 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